Diagnostic Accuracy of Spectral Doppler Indices and Sonoelastography in Predicting Malignancy in Breast Imaging Reporting and Database System 3 Breast Lesions With Histopathology as the Reference Standard

Introduction Breast cancer is a significant health concern in India, representing a large portion of all cancers affecting women and ranking as one of the most common cancers overall. Reliable diagnostic tools are essential for accurately predicting malignancy and reducing the need for unnecessary biopsies. A Breast Imaging Reporting and Database System (BI-RADS) 3 designation suggests a low likelihood of cancer, indicating that findings are likely benign. For these cases, short-term follow-up imaging is generally preferred over immediate biopsy as the probability of malignancy is minimal. This study evaluates the effectiveness of strain elastography, specifically the strain ratio, in predicting malignancy in BI-RADS 3 breast lesions in a cohort of 50 patients. Additionally, it examines the role of Doppler indices, including the Pulsatility Index (PI) and Resistance Index (RI). Histopathological analysis was used as the reference standard. Methods A descriptive cross-sectional study was conducted on 50 patients presenting with palpable breast lumps or abnormalities detected via ultrasonography or mammography. Conventional B-mode ultrasound examinations were performed on all the patients, and those with BI-RADS 3 lesions were identified. The Doppler technique was employed to calculate PI and RI values, followed by strain elastography to determine the strain ratio. Histopathological confirmation was performed for all patients. Results Histopathological analysis revealed that 92% (N=46) of the lesions were benign, while 8% (N=4) were malignant. For strain elastography, the sensitivity was 75%, specificity was 97.83%, positive predictive value (PPV) was 75%, negative predictive value (NPV) was 97.83%, and the diagnostic accuracy was 96%. For Doppler PI, the sensitivity was 75%, specificity was 95.65%, PPV was 60%, NPV was 97.78%, and the overall diagnostic accuracy was 94%. Similarly, for Doppler RI, the sensitivity was 75%, specificity was 95.65%, PPV was 60%, NPV was 97.78%, and the overall diagnostic accuracy was 94%. Conclusion B-mode ultrasound remains the first-line imaging investigation for evaluating breast masses. In BI-RADS 3 lesions, where the likelihood of malignancy is minimal, the combined use of strain elastography and Doppler PI and RI indices can serve as a valuable adjunct in predicting malignancy and reducing the need for unnecessary biopsies. Moreover, strain elastography demonstrates higher diagnostic accuracy compared to Doppler PI and RI.